Occipital fixation assembly, system and method for attaching the same

ABSTRACT

An occipital fixation assembly is provided. The occipital fixation assembly includes a first mounting plate configured for placement within a sinus cavity adjacent a rear portion of a skull of a patient. A threaded post extends from the first mounting plate. A coupling member includes an aperture configured to receive the threaded post therethrough. The coupling member includes an offset extension configured to support a surgical rod thereon. A fixation nut configured to threadably engage the threaded post of the first mounting plate is rotatable about the threaded post and translatable therealong. The fixation nut is rotatable with respect to the first mounting plate and the coupling member such that rotation of the fixation nut in a predetermined direction brings the first mounting plate and the coupling member toward one another and into secured engagement with the skull of a patient.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a division of U.S. patent application Ser.No. 14/288,903, filed on May 28, 2014, which is a division of U.S.patent application Ser. No. 12/904,613 filed on Oct. 14, 2010, which hasbeen abandoned, which claims the benefit of and priority to U.S.Provisional Application No. 61/278,925 to Sandhu et al., filed on Oct.14, 2009, the entire contents of each of which are incorporated byreference herein.

BACKGROUND

Technical Field

The present disclosure relates to an occipital fixation assembly, systemand method for attaching the same. More particularly, the presentdisclosure relates to an occipital fixation assembly that is configuredto support a surgical implant thereon and securely anchor to an insideof a skull of a patient.

Description of Related Art

As is commonly known in the art, an occipitocervical junction includesan occiput, atlas and axis. The occipitocervical junction is a uniqueinterface between the cranium and cervical spine. More than 50% of therotation and flexion-extension are provided from this region. Ligamentsin this region must resist forces about all six degrees of freedom.Moreover, instrumentation constructs not only must resist forces in allof these vectors, but also must resist the significant moment created bythe suboccipital bone and the cervical spine, which meet at a 50° angle.Any instrumentation construct designed for use in this region must,therefore, have adequate geometry to interface with the osseousstructures of the spinal structures as well as have sufficient rigidityand purchase to resist these forces until bone fusion can occur.

At one time, occipitocervical instability and lesions located at theoccipitocervical junction were considered inoperable and terminal. Sincethe first description of an occipitocervical fusion, multiple methods offusion in this region have been described. Descriptions of simple bonegrafts with halo immobilization; wire, pin, or hook constructs; rigidmetallic loops and rectangles fixed to the bone with either screws orwires; and most recently, plate or rod constructs with screws have allbeen described. In general the evolution of this technology has focusedon providing increasingly more rigid constructs to facilitate bonefusion and to minimize the need for and duration of externalimmobilization.

A common technique for fixing occipitocervical instability is the use ofan inverted Y-shaped screw plate. Using this technique, the plate issecured to C1-2 with transarticular screws and to the suboccipital bonewith paramedian screws; the suboccipital bone varies in thickness, witha mean thickness of 14 mm. Screws must be carefully selected to provideadequate purchase, yet avoid cerebella injury. Utilizing the maximumscrew length possible is critical because shorter screws have decreasedresistance to pullout. If stabilization is required below the C1-2level, then lateral mass screws can be placed through additional holesin a longer plate to include these levels as well. In certain instances,a bone graft may be added to promote fusion. The Y-shaped plate, incombination with transarticular screws, is an economical alternative.Immediate postoperative stabilization is achieved and very low rates ofpseudarthrosis have been reported. Due to the risk of selecting thecorrect screw size and the potential for cerebellar injury along withthe potential for screw pull-out due to the short nature of the screwlengths allowed for use, it may prove advantageous to provide anoccipital fixation assembly, and a system and method for attaching thesame that can reduce the chance for pull-out and reduce the risk forcerebellar injury.

SUMMARY

The present disclosure provides an occipital fixation assembly. Theoccipital fixation assembly includes a first mounting plate configuredfor placement within a sinus cavity adjacent a rear portion of a skullof a patient. A threaded post extends from the first mounting plate. Acoupling member includes an aperture configured to receive the threadedpost therethrough and an offset extension configured to support asurgical rod thereon. A fixation nut, configured to threadably engagethe threaded post of the first mounting plate, is rotatable about thethreaded post and translatable therealong. The fixation nut is rotatablewith respect to the first mounting plate and the coupling member suchthat rotation of the fixation nut in a predetermined direction bringsthe first mounting plate and the coupling member toward one another andinto secured engagement with the skull of a patient.

The present disclosure provides an occipital fixation system or systemfor attaching an occipital fixation assembly to a patient for subsequentattachment of a surgical rod thereto. The system includes a firstmounting plate configured for placement within a sinus cavity adjacent arear portion of a skull of a patient. The first mounting plate has athreaded post that extends therefrom. A coupling member includes anaperture configured to receive the threaded post therethrough. An offsetextension disposed in parallel orientation with respect to the threadedpost is configured to support a surgical rod thereon. A fixation nutconfigured to threadably engage the threaded post is rotatable about thethreaded post and translatable therealong. The fixation nut is rotatablewith respect to the first mounting plate and the coupling member suchthat rotation of the fixation nut in a predetermined direction bringsthe first mounting plate and the coupling member toward one another andinto secured engagement with the skull of a patient. A forceps isconfigured to grasp a portion of the threaded post when the threadedpost has been inserted through an aperture that has been previouslydrilled in the sinus cavity. A wrench assembly is adapted to engage and,subsequently, rotate the fixation nut about the threaded post.

The present disclosure also provides a method for attaching an occipitalfixation assembly to a patient for subsequent attachment of a surgicalrod thereto. The method includes creating an aperture within a sinuscavity adjacent a rear portion of a skull of a patient. A threaded postof a first mounting plate of an occipital fixation assembly is,subsequently, positioned through the aperture created within the sinuscavity. Thereafter, a coupling member of the occipital fixation assemblyis attached to the threaded post of the first mounting plate. A fixationnut is then positioned about the threaded post and, subsequently,rotated in a predetermined direction about the threaded post such thatthe first mounting plate and the coupling member move toward one anotherand into secured engagement with the skull of a patient. A surgical rodis coupled to the coupling member.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein withreference to the drawings wherein:

FIG. 1 is a perspective view of an occipital fixation assembly with asurgical rod secured thereon according to an embodiment of the presentdisclosure;

FIG. 2 is a front view of the occipital fixation assembly depicted inFIG. 1;

FIG. 3 is an exploded view of the occipital fixation assembly depictedin FIG. 1 with components separated;

FIG. 4 is an exploded view of a coupling member associated with theoccipital fixation assembly depicted in FIG. 1;

FIG. 5 is a perspective view of an alternative configuration of theoccipital fixation assembly depicted in FIG. 1;

FIG. 6 is a front view of the occipital fixation assembly depicted inFIG. 5;

FIGS. 7A-7C are perspective views illustrating a mounting plate of theoccipital fixation assembly depicted in FIG. 5 with the mounting plateshown in various configurations;

FIG. 7D is a cross-sectional view of the mounting plate depicted in theconfiguration of FIG. 7A taken along section line 7D-7D;

FIG. 8A is a perspective view of an alternative embodiment of a threadedpost that may be utilized with the occipital fixation assembly depictedin FIG. 1;

FIG. 8B is a side view of the threaded post depicted in FIG. 8A;

FIG. 9 is a perspective view of a surgical instrument grasping thethreaded post depicted in FIG. 8A;

FIG. 10 is an enlarged area of detail depicted in FIG. 9;

FIGS. 11A-11D are perspective views illustrating an occipital fixationsystem and method for attaching the occipital fixation assembly to apatient for subsequent attachment of a surgical rod thereto;

FIG. 12A is a cross-sectional view of a coupling member according toanother embodiment of the present disclosure;

FIG. 12B is the enlarged area of detail depicted in FIG. 12A; and

FIG. 13 is a rear view of the occipital fixation assembly depicted inFIG. 1 with the mounting plate shown being inserted within an occipitalsinus cavity of a patient.

DETAILED DESCRIPTION

In the following description, as is traditional, the term “proximal”refers to a portion of a surgical instrument closer to the operatorwhile the term “distal” refers to a portion of a surgical instrumentfarther from the operator. In addition, the term “cephalad” is used inthis application to indicate a direction toward a patient's head,whereas the term “caudad” indicates a direction toward the patient'sfeet. Further still, for the purposes of this application, the term“medial” indicates a direction toward the middle of the body of thepatient, whilst the term “lateral” indicates a direction toward a sideof the body of the patient (i.e., away from the middle of the body ofthe patient). The term “posterior” indicates a direction toward thepatient's back, and the term “anterior” indicates a direction toward thepatient's front. In the following description, well-known functions orconstructions are not described in detail to avoid obscuring the presentdisclosure in unnecessary detail.

With reference to FIGS. 1-7C, and initially with reference to FIG. 1, anoccipital fixation assembly 2 is illustrated. The occipital fixationassembly 2 is positionable within a sinus cavity adjacent a rear portionof the skull, lateral to a brain stem region, i.e., adjacent theocciput. To this end, the occipital fixation assembly 2 includes a firstmounting plate 4, a coupling member 6 and a fixation nut 8.

Continuing with reference to FIG. 1, the mounting plate 4 isillustrated. Mounting plate 4 includes a generally elongatedconfiguration having top and bottom surfaces 10 and 12, respectively. Inthe illustrated embodiments, the mounting plate 4 includes a slightcurvature or concavity “C” (see FIG. 2 for example) that is configuredto follow a contour of the occiput of a skull. As can be appreciated,this curvature or concavity facilitates anchoring the mounting plate 4to the occiput.

One or more barbs (two barbs 20 a and 20 b are shown in the drawings)are operably disposed on the top surface 10 of the mounting plate 4(FIG. 1). Barbs 20 a and 20 b are configured to facilitate anchoring themounting plate 4 into an interior surface of the skull of a patient andto minimize rotation of the mounting plate 4 when the fixation nut 8 isrotated about a threaded post 14 a (FIGS. 1-5) or movement of themounting plate 4 when installed in the occiput. The barbs 20 a and 20 binclude a generally conical configuration with a substantially pointedtip.

In one particular embodiment, to facilitate fixation of the mountingplate 4 to an interior surface of a skull, the barbs 20 a and 20 b mayreside in generally circumferential recesses 21 a and 21 b,respectively, see FIGS. 5-7C. The recesses 21 a and 21 b are configuredto engage soft tissue that may be disposed adjacent the interior surfaceof the skull. The barbs 20 a and 20 b are set into the recesses 21 a and21 b at a depth that allows a majority of a surface area of the barbs 20a and 20 b to sufficiently anchor into the interior surface of theskull.

With reference again to FIG. 1, the elongated post 14 a extends in agenerally orthogonal orientation from the top surface 10 such that themounting plate 4 has a generally “T” shape (FIG. 3). The elongated post14 a may be monolithically formed with the mounting plate 4 or may becoupled to the mounting plate 4 by one or more suitable couplingmethods, e.g., welded to the top surface 10 of the mounting plate 4. Inthe illustrated embodiments, the elongated post 14 a is monolithicallyformed with the mounting plate 4.

A plurality of threads 16 a extends along an outer circumferentialsurface of the elongated post 14 a. The plurality of threads 16 aextends along a majority of a length of the elongated post such that aportion of the elongated post 14 a adjacent the top surface 10 of themounting plate 4 is devoid of the plurality of threads 16 a (FIGS. 2 and3). This portion of the elongated post devoid of the plurality ofthreads 16 a serves as a relief for cutting the plurality of threads 16a. Moreover, this portion of the elongated post 16 a devoid of theplurality of threads allows a mountng plate 5 to be threaded over thethreaded post 16 a until the mounting plate 5 passes the plurality ofthreads 16 a where it can be rotated 360° (see FIG. 7A in combinationwith FIG. 7B) without advancing in or out of the occiput when beingdeployed into a final position (FIG. 7C), described in greater detailbelow. In certain instances, this portion of the elongated post devoidof the plurality of threads is intended to prevent “over-tightening” ofthe coupling member 6 to the elongated post 14 a.

In the embodiment illustrated in FIGS. 1-7C, a proximal end of thethreaded post 14 a includes a slot 17 (FIGS. 1 and 3) that is configuredto receive a working end of a driving device, e.g., a screwdriver (orthe like), that is configured to rotate the mounting plate 4 withrespect to the fixation nut 8 when the fixation nut 8 is positioned onthe threaded post 14 a. The driving tool may include a blade configuredfor receipt in the slot 17 for holding the mounting plate 4 in a desiredorientation while the fixation nut 8 is rotated about the threaded post14 a. Additionally, the slot 17 turns the threaded post 14 a (and, thus,the mounting plate 4) after the mounting plate 5 is pulled and set tothe inside surface of the occiput (with barbs 20 c and 20 d) to thefinal deployed cross position (FIG. 7C), described in greater detailbelow.

Continuing with reference to FIG. 1, the coupling member 6 isillustrated. Coupling member 6 is configured to operably couple to themounting plate 4 (or, in some instances, to mounting plate 4 and asecond mounting plate 5, see FIGS. 5-7C) and to engage an exteriorsurface of a skull. To these ends, coupling member 6 includes a basemember 36.

Base 36 includes a generally annular configuration defined by an outerperipheral wall 35 that joins respective bottom and top surfaces 31 and33 (FIGS. 1-4) to each other. Bottom surface 31 includes one or morebarbs, e.g., three barbs 20 e-20 g, disposed thereon (see FIG. 2 incombination with FIG. 4) that are configured in a manner as describedabove with respect to barbs 20 a-20 b. However, unlike barbs 20 a-20 bthat are configured to anchor into an interior surface of the skull,barbs 20 e-20 g are configured to anchor to an exterior surface of theskull. Top surface 33 is configured to support the fixation nut 8thereon. An aperture 32 (FIGS. 3 and 4) extends from the top surface 33to the bottom surface 31 and is configured to receive the threaded post14 a (or in certain embodiments, a threaded post 14 b, described ingreater detail below) and a portion of the fixation nut 8 therethrough.

Coupling member 6 is also configured to support the surgical rod “R”thereon (FIG. 1). To this end, coupling member 6 includes an offsetextension 34 (FIGS. 1-4).

Offset extension 34 is disposed in parallel orientation with respect tothe threaded post 14 a (or in some embodiments with respect to thethreaded post 14 b), see FIGS. 1-3 and 5-7. The offset extension 34includes a generally elongated slot 38 (FIGS. 3 and 4) having anintermittent threaded portion 40 (FIGS. 3 and 4 show one half of theintermittent threaded portion 40) configured to receive a set-screw 42(FIGS. 1-3) therein and a non-threaded portion 44 (FIGS. 3 and 4)configured to receive the surgical rod “R” therein (FIGS. 1 and 2). Thethreaded and non-threaded portions, 40 and 44, respectively, of theoffset extension 34 are arranged such that when the surgical rod “R” issecured thereto, the surgical rod “R” is oriented perpendicular to theset-screw 42 (FIGS. 1 and 2).

With reference again to FIG. 1, the fixation nut 8 is shown. Fixationnut 8 is configured to threadably engage the threaded post 14 a of themounting plate 4 (or in some instances threaded post 14 b (FIG. 8A)).Fixation nut 8 is rotatable about the threaded post 14 a andtranslatable therealong. Moreover, fixation nut 8 is rotatable withrespect to the mounting plate 4 and the coupling member 6 such thatrotation of the fixation nut 8 in a predetermined direction, e.g., aclockwise direction, brings the mounting plate 4 and the coupling member6 toward one another and into secured engagement with the skull of apatient.

Preferably, a bottom surface 48 of the fixation nut 8 includes agenerally elongated extension 50 that is configured to extend into anaperture 52 of a washer 54 and the aperture 32 of the base 36 (FIG. 4).The extension 50 is configured to facilitate positioning the fixationnut 8 about the threaded post 14 a (or threaded post 14 b) and thewasher 54 distributes or “spreads” a load of the fixation nut 8 evenlyacross the top surface 33 of the base member 36 when the fixation nut isrotated about the threaded post 14 a. In the embodiment illustrated inFIG. 4, the washer 56 has a generally conical shape and is also intendedto serve as a lock washer. While the fixation nut 8 and washer 56 havebeen described herein as two separate components that couple to thecoupling member 6, it is within the purview of the present disclosurethat the coupling member 6, fixation nut 8 and washer 56 may be formedas one integral component.

To facilitate fixation of occipital fixation assembly 2 a to an interiorsurface of a skull, a second mounting plate 5 may be operably coupled tothe mounting plate 4, see FIGS. 5-7C. To this end, the mounting plate 5includes an opening 23 of suitable dimension, see FIGS. 7A-7C. Moreparticularly, the opening 23 includes an outer diameter that is lessthan an outer diameter defined by an outer edge of the plurality ofthreads 16 a. The mounting plate 5 is rotatable about the threaded post14 a such that the mounting plate 5 may be rotated from a firstposition, e.g., a “nested position,” (FIGS. 7A and 7D) that is conducivefor positioning the mounting plates 4 and 5 adjacent to an interiorsurface of a skull, to a subsequent or anchoring position (FIGS. 7B-7C)that is conducive for securing or lagging the mounting plates 4 and 5 tothe interior surface of a skull. In the anchoring position, the mountingplates 4 and 5 may be disposed transverse to each other and form agenerally crisscross or “X” shape or configuration, as best seen in FIG.7C.

Mounting plate 5 includes one or more barbs, e.g., barbs 20 c and 20 d,disposed on a top surface 30 thereof. As described above with respect tobarbs 20 a and 20 b, barbs 20 c and 20 d may reside in correspondingrecesses 21 c and 21 d, respectively, see FIGS. 5-7C).

To facilitate positioning the mounting plates 4 and 5 inside theocciput, a bottom surface 28 of the mounting plate 5 includes a pair ofindents 25 a and 25 b that are configured to releasably engage the barbs20 a and 20 b (FIG. 7D); the indents 25 a and 25 b are shown engagedwith the barbs 20 a and 20 b, respectively and, as a result thereof, arenot explicitly shown. In the “nested” position, the mounting plate 5 andthe mounting plate 4 can be inserted together into an aperture or slotin the occiput and rotated together until a final position, e.g., ananchored position, is achieved for the mounting plate 5, which can beseated or anchored into the occiput by pulling the nested mountingplates 4 and 5 so that the barbs 20 c and 20 d on the mounting plate 5“dig” into the inside of the occiput. Subsequently, the mounting plate 4can be deployed to the final (cross) position (FIG. 7C) using the slot17 in the end of the threaded bolt. More particularly, the operable endof a screwdriver may be utilized to engage the slot 17 and,subsequently, turn the mounting plate 4 that disengages the barbs 20 aand 20 b from the respective indents 25 a and 25 b. The barbs 20 a and20 b on the mounting plate 4 may then be brought into contact with theinside of the occiput, thus, fixing both mounting plates 4 and 5 inplace.

To facilitate anchoring the mounting plates 4 and 5 into the interiorsurface of a skull, a bottom surface 28 of the mounting plate 5 includesa notched portion 24 that is configured to receive and/or mate with aportion, e.g., a corresponding notched portion 26 disposed on the topsurface 10, of the mounting plate 4 (FIGS. 7B and 7D). In the anchoredposition, the notched portions 24 and 26 enable the top surface 10 ofthe mounting plate and top surface 30 of the mounting plate 5 to beflush with each other, as best seen in FIG. 7D; this provides asubstantially uniform contact surface between the mounting plates 4 and5 and the interior surface of the skull. This substantially uniformcontact surface facilitates positioning the barbs 20 a-20 d adjacent tothe interior surface of the skull, which, in turn, ensures that thebarbs 20 a-20 d properly engage the interior surface of skull. As can beappreciated, having all the barbs 20 a-20 d properly engaged to theinterior surface of the skull reduces and/or eliminates the likelihoodof inadvertent movement of the mounting plates 4 and 5 after theoccipital fixation assembly 2 a has been affixed to the interior surfaceof the skull.

In use, an aperture is, initially, created within a sinus cavityadjacent a rear portion of a skull of a patient, i.e., adjacent theocciput. For purposes herein, the aperture may be created utilizing oneor more suitable surgical devices, e.g., a surgical drill.

Mounting plate 4 is positioned through the aperture created within thesinus cavity adjacent the occiput. Thereafter, coupling member 6 ispositioned about the threaded post 14 a (see FIG. 1 in combination withFIG. 3). In particular, with additional reference to FIG. 13, once thephysician creates the desired opening in the patient's skull, one end ofthe mounting plate 4 is inserted through the opening until the opposingend clears the surface of the skull and can be positioned beneath thesurface of the skull. Subsequently, the mounting plate 4 is moved in agenerally opposing direction such that the entire mounting plate 4 isdisposed beneath the surface of the skull (i.e. on the inside). Oncepositioned, the threaded post 14 a extends through the opening. Thisinstallation technique is applicable to all disclosed embodiments of theoccipital fixation assembly. As will be appreciated, the opening willhave a dimension that is slightly greater than the dimensions of themounting plate 4.

The fixation nut 8 including the washer 54 is positioned about thethreaded post 14 a and over the base 36 of coupling member 6. Forillustrative purposes, the fixation nut 8 including washer 54 is shownengaged with the coupling member 6. Subsequently, the fixation nut 8 isrotated in a predetermined direction, e.g., a clockwise direction, aboutthe threaded post 14 a. In one particular embodiment, a screwdriver (orother suitable device) is utilized to engage the slot 17 to facilitaterotation the mounting plate 4 and/or fixation nut 8. Rotation of thefixation nut 8 about the threaded post 14 b causes the coupling member 6and the mounting plate 4 to move toward one another and into securedengagement with an interior and exterior surface, respectively, of theskull of a patient. As a result thereof, the occiput is “sandwiched”between the surgical rod coupling member 6 (with barbs 20 e-20 g) andmounting plate 4 (with barbs 20 a-20 b) by threading the fixation nut 8over the threaded post 14 a and tightening to the specified torque.

In some surgical scenarios, the occiput is “sandwiched” between thesurgical rod coupling member 6 (with barbs 20 e-20 g) and mountingplates 4 and 5 (with barbs 20 a-20 d) by threading the fixation nut 8over the threaded post 14 a and tightening to the specified torque.

Thereafter, the surgical rod “R” is coupled to the offset extension 34of the coupling member 6 and secured to the coupling member 6 via theset screw 42.

As can be appreciated, the combination of the unique mounting plate 4having the threaded post 14 a configured to couple to the couplingmember 6 reduces and/or eliminates the likelihood of the occipitalfixation assembly 2 inadvertently pulling out from the occiput, which,in turn, reduces the risk for cerebellar injury. Moreover, anchoring thebarbs 20 a-20 b and the barbs 20 e-20 g into the interior and exteriorsurfaces, respectively, of the skull diminishes the likelihood ofinadvertent rotation of mounting plate 4 and coupling member 6 after thesurgical rod “R” has been attached to the occipital fixation assemblyand/or the spine.

With reference to FIGS. 8A and 8B, an alternate embodiment of anelongated post is designated elongated post 14 b. In this embodiment,the elongated post 14 b is provided without the slot 17. Moreparticularly, unlike the elongated post 14 a, elongated post 14 bincludes a plurality of non-continuous threads 16 b extending partiallyalong an outer circumferential surface of the elongated post 14 b. Aproximal end of the elongated post 14 b includes a threaded aperture 19that extends into the threaded post 14 b (FIG. 8A). The threadedaperture 19 is configured to receive one end of a surgical device, e.g.,wrench assembly 80, for positioning and turning the fixation nut 8 aboutthe threaded post 14 b (FIGS. 11A-11D). A non-threaded aperture 21extends traverse to the threaded aperture 19 and is configured toreceive one end of a surgical device, e.g., a forceps 60, for graspingthe threaded post 14 b and maintaining the mounting plate 4 a in anon-rotatable state when the fixation nut 8 is rotated about theelongated post 14 b (FIGS. 9-11B).

With reference to FIGS. 9-11D, system 100 includes a forceps 60 (FIGS. 9and 11A-11C), a wrench assembly 80 (FIGS. 11A-11D) and the occipitalfixation assembly 2 b (FIG. 11D) that includes the mounting plate 4 awith the threaded post 14 b (FIG. 10).

Forceps 60 is configured to grasp a portion of the threaded post 14 b(as best seen in FIG. 10). More particularly, the forceps 60 may beutilized to grasp the threaded post 14 b to facilitate positioning themounting plate 4 within the aperture created within the sinus cavityadjacent a rear portion of a skull of a patient, i.e., the occiput.Moreover, and as noted above, forceps 60 may be utilized to grasp thethreaded post 14 b to maintain the mounting plate 4 a in a non-rotatablestate when the fixation nut 8 is rotated about the elongated post 14 b.Forceps 60 includes first and second shafts 61 and 62. Each shaft 61 and62 has a respective jaw member 63 and 64 extending from a distal endthereof and a handle 65 and 66 disposed at a proximal end thereof foreffecting movement of the jaw members 63 and 64 relative to one anotherabout a pivot 67. The jaw members 63 and 64 are movable from a firstposition (FIG. 11C) wherein the jaw members 63 and 64 are disposed inspaced relation relative to one another to a second position wherein thejaw members 63 and 64 cooperate to grasp the threaded post (FIGS.9-11B).

Each of the jaw members 63 and 64 includes a respective inner facingsurface 69 and 68 (FIGS. 10 and 11C) having a respective proximal end 70and 71 (FIG. 9) and a respective distal end 72 and 73 that is offsetfrom the proximal end 70 and 71 (FIG. 10). In the closed configuration,the distal ends 72 and 73 of the inner facing surfaces 69 and 68 remainspaced-apart from each other to facilitate grasping the threaded posttherebetween (FIGS. 9-11A).

The distal ends 72 and 73 of the jaw members 63 and 64 include aprotrusion 74 and 75 (FIGS. 10 and 11C) thereon that is configured toreleasably engage the non-threaded aperture 21 on the threaded post 14b.

A ratchet mechanism 90 may be operably coupled to the shafts 61 and 62adjacent the handles 65 and 66 and is configured to maintain the jawmembers 63 and 64 in one or more positions. More particularly, eachshaft 61 and 62 includes a respective ratchet component 90 a and 90 beach having a plurality of ratchet teeth that are configured to matinglyengage with one another.

As can be appreciated, in the instance where the occipital fixationassembly 2 includes a mounting plate 4 with a threaded post 14 a, theinner facing surfaces 69 and 68 of the forceps 60 may be providedwithout the protrusions 74 and 75. For example, the inner facingsurfaces 69 and 68 of forceps 60 may include one or more slots orgrooves that are configured to matingly engage with the plurality ofthreads 16 a on the threaded post 14 a.

Wrench assembly 80 is configured to rotate the fixation nut 8 about thethreaded post 14 b (FIGS. 11B and 11C). Wrench assembly 80 includes acoupling member 81 that is configured to threadably engage the threadedaperture 19 on the threaded post 14 b of the mounting plate 4 (FIGS.11A-11C). Wrench assembly 80 includes a wrench head member 82 that isselectively and coaxially engageable with the coupling member 81 (FIGS.11A-11C).

The coupling member 81 includes a generally elongated shaft 83 (FIGS.11A and 11D) having a threaded distal end 84 (FIGS. 11A and 11C), andproximal end 85 that is configured to rotate the threaded distal end 84into the threaded aperture 19 of the threaded post 14 b of the mountingplate 4 a for securement of the coupling member to the mounting plate 4.

A portion 86 (FIGS. 11A and 11D) of the coupling member 81 proximate tothe threaded distal end 84 has an outer diameter that is slightlysmaller than an inner diameter of the fixation nut 8, so that thefixation nut 8 can slide over portion 86. The portion 86 is configuredto facilitate positioning the fixation nut 8 on the threaded post 14 bof the mounting plate 4 a. More particularly, the portion 86 isconfigured to guide the fixation nut 8 into position on the threadedpost 14 b. In one particular embodiment, the elongated extension 50 ofthe fixation nut 8 is configured to slide over the portion 86 and guidethe fixation nut 8 into position on the threaded post 14 b

The proximal end 85 of the coupling member 81 is complementary shaped toreceive an open end of a turn-key 87. In the illustrated embodiment, theproximal end 85 and the open end of the turn-key 87 include a hexagonalshape. The turn-key 87 is configured to facilitate rotation of thethreaded distal end 84 into the threaded aperture 19 on the threadedpost 14 b of the mounting plate 4 a.

In the embodiment illustrated in FIGS. 11A-11D, a portion 88 of theshaft 81 proximate to the threaded distal end 84 is textured orotherwise treated to provide an additional gripping surface for a user,or to provide mechanical interface for maintaining the turn-key 87 atthe proximal end 85.

The wrench head member 82 is configured to releasably engage thefixation nut 8 and rotate the fixation nut 8 about the threaded post 14b of the mounting plate 4 a. To this end, the wrench head member 82 iscomplementary shaped to receive and turn the fixation nut 8. In theembodiment illustrated in FIGS. 11A-11D, a proximal end 89 of the wrenchhead member 82 is textured or otherwise treated to facilitate rotationof the wrench member head. As can be appreciated, the wrench head member82 may be utilized to rotate the fixation nut 8 about the threaded post14 a.

Operation of the system 100 including the occipital fixation assembly 2b including the mounting plate 4 a with the threaded post 14 b isdescribed in terms of use of a method for attaching the occipitalfixation assembly 2 b for subsequent attachment of a surgical rod “R”thereto.

An aperture is created within a sinus cavity adjacent a rear portion ofa skull of a patient. For purposes herein, the aperture may be createdutilizing one or more suitable surgical devices, e.g., a surgical drill.

The forceps 60 may be utilized for grasping the threaded post 14 b toinsert the mounting plate 4 a through the aperture created within thesinus cavity and to temporarily hold the threaded post 14 b in place(FIGS. 9-11B). Thereafter, coupling member 6 is positioned about thethreaded post 14 b.

The fixation nut 8 including the washer 54 is positioned about thethreaded post 14 b and over the base 36 of coupling member 6. Tofacilitate positioning the fixation nut 8 about the threaded post 14 b,the coupling member 81 of the wrench assembly 80 may be coupled to thethreaded post 14 b, see FIG. 11A where the coupling member 81 is shownadjacent the threaded post 14 b just before coupling the coupling member81 to the threaded post 14 b. The turn-key may be utilized to facilitateturning the coupling member 81 about the threaded post 14 b.

Subsequently, the fixation nut 8 is rotated in a predetermineddirection, e.g., a clockwise direction, about the threaded post 14 b. Tofacilitate rotating the fixation nut 8 about the threaded post 14 b, thewrench head member 82 may be positioned coaxially about the couplingmember 81 and into engagement with the fixation nut 8 (FIG. 11B). Itshould be noted that once the fixation nut 8 has been engaged to thethreaded post 14 b, the forceps 60 may be removed from engagement withthe threaded post 14 b (FIG. 11C). It is further contemplated that thethreaded engagement between to threaded distal end 84 and the threadedaperture 19 may be opposed to the threaded engagement between fixationnut 8 and post 14 b (i.e., one may engage in a clockwise direction andthe other in a counterclockwise direction) so that as the fixation nut 8is tightened the coupling member 81 does not loosen from the threadedpost 14 b. In this manner, even after the forceps 60 have been removed,control may be exerted over the threaded post 14 b as the fixation nut 8is tightened.

The wrench head member 82 is rotated about the fixation nut 8, which, inturn, rotates the fixation nut 8 about the threaded post 14 b, this inturn, causes the coupling member 6 and the mounting plate 4 a to movetoward one another and into secured engagement with an interior andexterior surface, respectively, of the skull of a patient.

In one surgical scenario, after the coupling member 6 and the mountingplate 4 a are moved into secured engagement with the interior andexterior surface of the skull, the wrench assembly 80 is removed fromthe occipital fixation assembly 2 (FIG. 11D). Thereafter, the surgicalrod “R” is coupled to the offset extension 34 of the coupling member 6and secured to the coupling member 6 via the set screw 42.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. For example, in some embodiments the slot 38 of the offsetextension 34 includes a taper locking mechanism for capturing thesurgical rod “R” such that a set screw 42 is not required.

In yet another embodiment, the slot 38 of the offset extension 34includes a polyaxial coupling for capturing the surgical rod “R” suchthat an angle and trajectory of the surgical rod “R” does not limit theposition of the occipital fixation assembly 2.

In yet another embodiment, a fixation nut may be integrally formed witha coupling member. More particularly, and with reference to FIGS. 12Aand 12B, a coupling member 6A and a fixation nut 8A are integrallyformed with one another via one or more suitable coupling methods, e.g.,soldering, brazing or welding. In this instance, the fixation nut 8A isswaged, but rotatable, to the coupling member 8A along with a washermaking it an integral assembly. In this instance, the coupling member 6Aincluding the fixation nut 8A are positioned about the threaded post 14b simultaneously.

While several embodiments of the disclosure have been shown in thedrawings and/or discussed herein, it is not intended that the disclosurebe limited thereto, as it is intended that the disclosure be as broad inscope as the art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

1. (canceled)
 2. An occipital fixation system, comprising: an occipitalfixation assembly, including: a first mounting plate configured forplacement within a sinus cavity adjacent a rear portion of a skull of apatient, the first mounting plate having a threaded post extendingtherefrom; a coupling member including an aperture configured to receivethe threaded post therethrough, the coupling member including an offsetextension disposed in parallel orientation with respect to the threadedpost and configured to support a surgical rod thereon; and a fixationnut configured to threadably engage the threaded post, the fixation nutrotatable about the threaded post and translatable therealong, thefixation nut rotatable with respect to the first mounting plate and thecoupling member such that rotation of the fixation nut in apredetermined direction brings the first mounting plate and the couplingmember toward one another and into secured engagement with the skull ofa patient; a forceps configured to grasp a portion of the threaded postto facilitate positioning of the first mounting plate through anaperture that has been previously drilled into the sinus cavity; and awrench assembly configured to engage and, subsequently, rotate thefixation nut about the threaded post.
 3. The occipital fixation systemaccording to claim 2, wherein a first barb is operably disposed on a topsurface of the first mounting plate and a second barb is operablydisposed on a bottom surface of the coupling member.
 4. The occipitalfixation system according to claim 3, wherein the first and second barbsare configured to anchor into an inside of the skull and outside of theskull, respectively, to minimize respective rotation of the firstmounting plate and coupling member when the fixation nut is rotatedabout the threaded post.
 5. The occipital fixation system according toclaim 2, wherein a washer is disposed between the fixation nut and theaperture on the coupling member and serves as a lock washer, wherein abottom surface of the fixation nut is receivable through the washer andat least partially extends through the aperture of the coupling member,wherein the fixation nut is swaged to the coupling member making thecoupling member and fixation nut an integral assembly.
 6. The occipitalfixation system according to claim 2, wherein the offset extensionincludes a generally elongated slot having a threaded portion configuredto receive a set-screw therein and a non-threaded portion configured toreceive the surgical rod therein, the threaded and non-threaded portionsof the offset extension arranged such that when the surgical rod issecured thereto, the surgical rod is oriented perpendicular to theset-screw.
 7. The occipital fixation system according to claim 2,wherein a second mounting plate is operably coupled to the firstmounting plate and is rotatable about the threaded post.
 8. Theoccipital fixation system according to claim 7, wherein a bottom surfaceof the second mounting plate is notched and configured to receive atleast a portion of the first mounting plate therein such that a topsurface of the first mounting plate and a top surface of the secondmounting plate are flush with each other and the first and secondmounting plates are disposed transverse to each other when the first andsecond mounting plates are attached to a skull of a patient.
 9. Theoccipital fixation system according to claim 8, wherein the bottomsurface of the second mounting plate includes a pair of indentsconfigured to releasably receive a corresponding pair of barbs operablydisposed on the top surface of the first mounting plate, the pair ofindents configured to maintain the first mounting plate in a relativelyfixed orientation with respect to the second mounting plate tofacilitate positioning the first and second mounting plates inside askull.
 10. The occipital fixation system according to claim 2, whereinthe threaded post of the first mounting plate includes a threadedaperture and a non-threaded aperture that extends transverse to thethreaded aperture, the threaded aperture configured to receive one endof a surgical device for turning the fixation nut about the threadedpost and the non-threaded aperture configured to receive one end of asurgical device for grasping the threaded post.
 11. The occipitalfixation system according to claim 10, wherein the forceps includesfirst and second shafts, each shaft having a jaw member extending from adistal portion thereof and a handle disposed at a proximal portionthereof for effecting movement of the jaw members relative to oneanother about a pivot, the jaw members movable from a first positionwhere the jaw members are disposed in spaced relation relative to oneanother to a second position where the jaw members cooperate to graspthe threaded post.
 12. The occipital fixation system according to claim11, wherein each jaw member is curved and includes an inner facingsurface having a proximal end and a distal end that is offset from theproximal end such that in the closed configuration the distal ends ofthe inner facing surfaces remain spaced-apart from each other tofacilitate grasping the threaded post therebetween, at least one of thedistal ends of the jaw members including a protrusion thereon that isconfigured to releasably engage the non-threaded aperture on thethreaded post.
 13. The occipital fixation system according to claim 11,wherein the wrench assembly comprises: a coupling member configured tothreadably engage the threaded aperture on the threaded post of thefirst mounting plate; and a wrench head member selectively and coaxiallyengageable with the coupling member, the wrench head member configuredto releasably engage the fixation nut and rotate the fixation nut aboutthe threaded post of the first mounting plate, wherein a proximalportion of the coupling member is configured to receive an end portionof a turn-key for facilitating rotation of a distal end portion of thecoupling member into the threaded aperture of the threaded post of thefirst mounting plate.
 14. The occipital fixation system according toclaim 13, wherein the coupling member includes a generally elongatedshaft having a threaded distal end portion and a proximal end portionthat is configured to rotate the threaded distal end portion into thethreaded aperture of the threaded post of the first mounting plate forsecurement of the coupling member to the first mounting plate.
 15. Theoccipital fixation system according to claim 14, wherein a portion ofthe coupling member proximate to the threaded distal end has an outerdiameter that is slightly smaller than an inner diameter of the fixationnut, the portion of the coupling member proximate to the threaded distalend configured to facilitate positioning of the fixation nut on thethreaded post of the first mounting plate.
 16. The occipital fixationsystem according to claim 2, wherein the threaded post of the firstmounting plate defines an end face having a transverse slot definedtherein, the slot configured to receive a portion of a screwdrivertherein.
 17. The occipital fixation system according to claim 2, whereinthe threaded post is integral to the first mounting plate.